Effectiveness of Prescription Monitoring Programs in Reducing Opioid Prescribing, Dispensing, and Use Outcomes: A Systematic Review

Wilson, Maria; Hayden, Jill A.; Rhodes, Emily; Robinson, Alysia; Asbridge, Mark

doi:10.1016/j.jpain.2019.04.007

Cited by 43 publications

(42 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this study, refill rates were used as a proxy for pain control after discharge, although refill rates may be confounded by several variables such as limited patient access, hesitation to provide refill prescriptions, and opioid acquisition through diversion from friends or family. 33…”

Section: Discussionmentioning

confidence: 99%

A Goal-directed Quality Improvement Initiative to Reduce Opioid Prescriptions After Orthopaedic Procedures

et al. 2019

View full text Add to dashboard Cite

Introduction:Orthopaedic surgeons are increasingly aware of deleterious effects of the opioid epidemic and the association between overprescription and diversion toward nonmedical opioid use or substance abuse. Opiate prescriptions at the time of hospital discharge have been identified as target for intervention. This study describes the successful outcome of a goal-directed intervention aimed at decreasing opioid overprescription by providing routine feedback to providers regarding their prescribing patterns.Methods:The amount of opioid medications, quantified as oral morphine equivalents (OMEs), provided to opioid-naive adult patients on discharge after orthopaedic surgery was prospectively collected. As part of an institutional quality improvement initiative, medical providers received reports every 2 months detailing median discharge OMEs prescribed, trended over time. After 6 months, a retrospective comparison was done between preintervention and intervention patient cohorts.Results:There were 401 patients in the preintervention cohort and 429 patients in the intervention cohort. Both groups were similar in regard to age, sex, rates of depression, surgical time, length of stay, orthopaedic subspecialty, and inpatient opioid requirement before discharge. Patients in the intervention cohort were prescribed markedly fewer opioid medications by 25%, equivalent to 20 tablets of 5-mg oxycodone IR (450 versus 600 OMEs, P < 0.001). Despite these opioid medications, opioid refill rates during the first 90 days after discharge did not markedly change between groups.Discussion:It is critical to judiciously treat postoperative pain while avoiding opioid overprescription. This study demonstrated the outcome of a goal-directed initiative to decrease overprescription of opioid medications. The initiative reduced discharge opioid prescriptions yet did not increase the risk of requiring a prescription refill in the postoperative period. This indicates that such an approach can result in opioid reduction, while still providing appropriate care and pain control for patients.

show abstract

Section: Discussionmentioning

confidence: 99%

A Goal-directed Quality Improvement Initiative to Reduce Opioid Prescriptions After Orthopaedic Procedures

et al. 2019

View full text Add to dashboard Cite

show abstract

“…A recent meta-analysis did not find, however, evidence to support an association between PMPs and decreased opioid prescribing. 52 In fact, a recent examination of the effects of a law mandating that providers review PMP data before prescribing opioids in the emergency department found no differences in pre-PMP legislation to post-PMP legislation on the prescribing of opioids. 53 The percentages of patients prescribed opioids and the morphine milligram equivalent doses were exactly the same.…”

Section: Discussionmentioning

confidence: 99%

An Effective Intervention: Limiting Opioid Prescribing as a Means of Reducing Opioid Analgesic Misuse, and Overdose Deaths

Fink¹,

Uyttebrouck²,

Larson³

2020

J. Law. Med. Ethics

View full text Add to dashboard Cite

Overdose deaths involving prescription opioids killed more than 17,000 Americans in 2017, marking a five-fold increase since 1999. High prescribing rates of opioid analgesics have been a substantial contributor to prescription opioid misuse, dependence, overdose and heroin use. There was recognition approximately ten years ago that opioid prescribing patterns were contributing to this startling increase in negative opioid-related outcomes, and federal actions, including Medicare reimbursement reform and regulatory actions, were initiated to restrict opioid prescribing. The current manuscript is a description of those actions, the effect of those actions on opioid prescribing and related patient outcomes. We also describe our proposal of methods of expanding these efforts as an important piece to further reduce opioid-related misuse, dependence, and overdose death.

show abstract

“…7 PMPs have been implemented in a majority of states and have been associated with a decrease in prescription of schedule two opioids (e.g., hydromorphone and oxycodone). 17 However, limited data exist surrounding the relationship between a PMP and a reduction in multiple provider prescriptions or inappropriate prescribing patterns. 17 Our data call into question the overall accuracy of the PMP in identifying patients at high likelihood for filling a prescription opioid in the postoperative setting.…”

Section: Discussionmentioning

confidence: 99%

How Reliable Is a Statewide Prescription Monitoring Program for Identifying Post-Cesarean Opioid Use?

Premkumar

Speedy

2020

AJP Rep

View full text Add to dashboard Cite

Objective This study was aimed to estimate the percentage of women taking opioids post-cesarean who could be detected in a state prescription monitoring program (PMP) and characteristics of those not able to be detected. Study Design This observational cohort study included all women with an Illinois address who delivered via cesarean section and used opioids within 24 hours prior to discharge at a tertiary care hospital between August 21, 2017 and March 1, 2018. The Illinois PMP was queried for presence of an opioid prescription filled within the first 3 months postpartum. Sociodemographic and clinical factors associated with an undetectable PMP record were evaluated in bivariable and multivariable logistic regression analyses. Results A total of 517 women underwent a cesarean delivery during the study period, of whom 344 (66.5%) met inclusion criteria. Of these women, 169 (49%) did not have a detectable PMP record of filling any outpatient postpartum prescription opioid. On bivariable and multivariable logistic regression analysis, year of delivery (2018 vs. 2017) was significantly associated with a higher incidence of detectable postpartum prescription opioid record in the PMP with increasing relative risk of detectable records in the second year of analyses (n = 110/244 [45%] in 2017 vs. n = 59/100 [59%] in 2018, adjusted risk ratio [aRR] = 1.32, 95% confidence interval [CI]: 1.06–1.64, p = 0.013). No other sociodemographic or clinical characteristics was significantly associated. Conclusion Nearly half of women who underwent a cesarean section and who were administered opioids 24 hours prior to discharge did not have a detectable postpartum opioid prescription in the PMP. While identification of prescription filling improved with time, many of women were not detectable in the PMP system. These data call into question the accuracy of PMPs in identifying prescription opioid filling patterns in the postpartum setting.

show abstract

Effectiveness of Prescription Monitoring Programs in Reducing Opioid Prescribing, Dispensing, and Use Outcomes: A Systematic Review

Cited by 43 publications

References 42 publications

A Goal-directed Quality Improvement Initiative to Reduce Opioid Prescriptions After Orthopaedic Procedures

A Goal-directed Quality Improvement Initiative to Reduce Opioid Prescriptions After Orthopaedic Procedures

An Effective Intervention: Limiting Opioid Prescribing as a Means of Reducing Opioid Analgesic Misuse, and Overdose Deaths

How Reliable Is a Statewide Prescription Monitoring Program for Identifying Post-Cesarean Opioid Use?

Contact Info

Product

Resources

About